心脏负荷试验评价冠状动脉介入治疗疗效的初步临床应用

Primary Application of Heart Stress Tests in Evaluating the Clinical Effect of Percutaneous Transluminal Coronary Angioplasty

为探讨心电图和核素心肌显像负荷试验在评价冠状动脉成形术（ＰＴＣＡ）疗效中的临床意义，对接受ＰＴＣＡ的６４例患者于ＰＴＣＡ前、术后７～１４天、３～６个月及１０～１２个月分别进行心电图活动平板试验及核素心肌显像负荷试验。结果表明，两种负荷试验对再狭窄的阳性预测值分别为８５７％和９２３％；ＰＴＣＡ前静息与负荷时心肌灌注缺损积分之差和ＰＴＣＡ后心肌灌注的改善程度显著相关。说明两种负荷试验均能敏感地检测ＰＴＣＡ前后心肌供血的变化和再狭窄，并对检测再狭窄的心脏负荷试验选择方案提出了建议。

To investigate the clinical significance of treadmill exercise electrocardiography (TEE),stress nuclide myocardiotomography (SNMT) in evaluating the curative effect of percutaneous transluminal coronary angioplasty (PTCA),sixty-four patients were studied prospectively with TEE,rest nuclide myocardiotomography (RNMT) and SNMT before PTCA,7～14 days,3～6 months and 10～12 months after PTCA.Coronary angiography was taken in those patients who had recurrence of suspicious chest pain,and/or one or more positive results in their heart stress tests.The results showed that,compared with those before PTCA,heart rate index,maximal exercise time,ST-segment ischemic index and the myocardial perfusion defect scores were improved significantly at 7～14 days and got to the peak at 3～6 months after PTCA.Restenosis was confirmed in 12 patients by coronary angiography.Positive prediction values for restenosis were 85.7% and 92.3% in TEE and SNMT,respectively.The difference of myocardial perfusion scores between RNMT and SNMT before PTCA was related to the degree of myocardial perfusion improvement after PTCA.Those indicated both of TEE and SNMT were sensitive to detect the changes of myocardial ischemia and maximal exercise capacity between before and after PTCA.A protocol was suggested for choice of heart stress tests in follow-up after PTCA.SNMT was helpful for predicting the effect of PTCA.